IRAQ SEEKS IAEA/PACT PARTNERSHIP TO LAUNCH NATIONAL CANCER

UNCLAS UNVIE VIENNA 000191

C O R R E C T E D C O P Y (ADDED ADDRESSEE)

SIPDIS

STATE FOR IO/T, ISN/MNSA, ISN/RA, ISN/CTR
NA-243-GOOREVICH/OEHLBERT, BRUNNS; NA-241 O'CONNOR, SIEMON;
NA21-CUMMINS, ILIOPULOS; NE- MCGINNIS, PEKO, CLAPPER
NRC FOR OIP - DOANE, HENDERSON, SCHWARTZMAN
BAGHDAD FOR RUTH HALL, MILA UYEHAVA, TIM FINGARSON AND USAID

E.O. 12958: N/A
TAGS: AORC ENRG ETTC KNNP MNUC PREL TRGY
SUBJECT: IRAQ SEEKS IAEA/PACT PARTNERSHIP TO LAUNCH NATIONAL CANCER
THERAPY PROGRAM

REF: A) 08 UNVIE 556, B) UNVIE 145

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SUMMARY AND ACTION REQUEST
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1. In March 2009, after a five month lag, Iraq's Ministry of Health
(MOH) resumed discussions with the IAEA Program of Action for Cancer
Therapy (PACT) to create a short, medium, and long-term plan to
implement a national cancer therapy program. After consultation
with multiple IAEA offices that would be involved in the project,
PACT shared a roadmap with Msnoff in order to gain U.S. support for
the removal of old cobalt-60 sources, procurement of new linear
accelerators, and long-term financial support for the Iraq/PACT
partnership. The Iraqi MOH's next step is to gain interagency
approval in Baghdad and per PACT's advice approach other potential
donors (Japan, China, and Canada) to ensure that the total cost of
USD 2.3 to USD 3.5 million for short-term goals is reached quickly.
The implementation of medium and long-term elements will begin only
if Iraq finds donors and submits appropriate TC project requests to
the IAEA and Member States for consideration. The IAEA has not yet
committed any TC or reserve funds toward this project.


2. Mission requests guidance on USG views of the Iraq/PACT
partnership, possible assistance on removal of cobalt-60 sources,
possible training opportunities of Iraqi experts in the U.S., and
USG funding support. END SUMMARY AND ACTION REQUEST.

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HOW THIS ALL GOT STARTED
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3. In spring 2008, Mission provided, through the Embassy Baghdad
Health Attache's office, an IAEA Program of Action for Cancer
Therapy (PACT) "imPACT" questionnaire, which the Iraqi Ministry of
Health and the Ministry of Science and Technology completed in
August 2008. PACT subsequently produced an analysis of nuclear
applications for cancer therapy, based on the GOI's responses.
During the 2008 IAEA General Conference, Msnoffs participated in a
meeting with the Iraqi Delegation and PACT to clarify short, medium,
and long-term needs and assistance PACT might provide in Iraq.
Mission conveyed general U.S. support for PACT, but made no
commitments related to this project, though Iraqi interlocutors
pressed for such assistance. Instead, the next step discussed was
the GOI's need to delineate a timeline, strategy, and cost estimate
for donors to consider. PACT offered assistance in formulating a
project package for donors. After months of inaction, caused at
least in part by Austrian visa delays, Iraq recently sent two
experts from the Ministry of Health to Vienna for March 30-April 4
consultations with PACT (ref B).

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IRAQ-PACT CONSULTATION RESULTS
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4. PACT arranged for a week of meetings with Nuclear Applications
(Applied Radiation and Biology and Radiotherapy Section/Dosimetry
and Medical Radiation Physic Section/Nuclear Medicine Section),TC,
and program experts for Iraqi Ministry of Health representatives Dr.
Ahmed Sabah Nooredin and Dr. Mahdi Abdullah Al Saraj from the main
cancer hospital in Baghdad. The Iraqi experts presented an account
of their current oncology services across Iraq and then worked with
IAEA counterparts on devising a plan for short/medium/long term
priorities which are now divided into three phases (Phase I -
immediate action in 2009/Phase II - action mid-2010-2011/Phase II -
action beyond 2012.) Estimated resources and possible funding
sources were also identified. Based on the discussion, prior to
departing, the Iraqi experts presented a draft project concept for
the rehabilitation of the main cancer and nuclear medicine centers
in Baghdad and Mosul and defined it as a Phase I need. According to
the experts they will ask the Ministry of Health and Ministry of
Science and Technology to submit this project concept as a TC
project request with the TC reserve Fund as the funding source.
PACT Director Samiei, in a separate conversation with Msnoff, noted
that the IAEA may designate USG 50,000 from the TC Reserve Fund for
this project after approval.


5. The draft project concept will address the most urgent needs of
the two cancer centers in Mosul and Baghdad. According to the draft
outline the project requests:

-- Six Cobalt-60 source replacements (2 for Mosul/4 for Baghdad),

the decommissioning of old machines, and assistance procuring new
machines;
-- in the event that importation of Cobalt 60 replacement sources is
not feasible, Iraq requests assistance in procuring two linear
accelerators (compact 6MeV);
-- intracavitary afterloading;
-- assistance with improving radiopharmaceuticals for nuclear
medical examinations;
-- support for a comprehensive cancer control plan based on the PACT
process;
-- training courses: a) short-term program for three months for
teams consisting of 4 radiation oncologists, 1 nuclear medicine
physician, 4 radiotherapy technicians, 2 physicists, and 1 engineer;
b) medium-term programs for 2 radiation oncologists, 2 radiotherapy
technicians, 1 physicist, 1 engineer, and 1 nuclear medicine
physician; c) long-term programs lasting 1-2 years for 3 radiation
oncologists, 3 radiotherapy technicians, 2 physicists and 1 nuclear
medicine physician.

The IAEA's TC Division and Iraqi experts agreed that Phase II and
Phase III needs, not defined as of April 2009, in radiotherapy and
nuclear medicine, should be addressed through Iraqi submissions of
regular TC project proposals in 2010 for approval by the TACC. Iraqi
participation in existing regional TC projects will also address
some needs.


6. Iraqi experts also briefed Nuclear Application's Medical Physics
and Dosimetry expert Pernika on current equipment inventories at the
four radiotherapy centers in Iraq. The total inventory is:
-- Baghdad - 4 Cobalt-60 units, 2 Primus linear accelerators, 1 CT
simulator (Siemens),1 TPS
-- Mosul - 2 Cobalt 60 units, 1 Primus linear accelerator, 1 CT
simulator, 1 TPS
-- Arbil - 1 Primus linear accelerator, 1 CT simulator, 1 TPS
-- Suleimania - 1 Elekta linear accelerator, other equipment
unknown

The centers and equipment are being staffed by a total of 80 experts
with a variety of educational backgrounds (Master or Bachelors in
Science and Medicine, etc.). According to IAEA/NA and the Iraqi
experts, the urgent need for Phase I and Phase II is the training of
medical physicists. Short-term training, from IAEA/NA's perspective
should focus on dosimetry, treatment planning, quality assurance,
and radiation protection. For Phase II training needs, Iraq should
consider sending two medical physicists on a 1-2 year clinical
rotation in a major hospital in the region or elsewhere. As a first
step, IAEA/NA agreed to provide Iraqi counterparts with necessary
material for teaching and training medical physicists especially in
radiation oncology. IAEA/NA will also provide further
recommendation on clinical training opportunities.


7. A common thread throughout the consultations, according to PACT,
was Iraq's need for funding. According to the Iraqi experts, there
are limited amounts of funding available from the Ministry of Health
or the Ministry of Science. PACT once again suggested that the
Iraqis brief Member States and potential donors on their plans in an
effort to solicit funds. PACT will continue partner with Iraq and
will try to mobilize funding from other international organizations
or NGOs on behalf of Iraq.


8. PACT requested U.S. support, on behalf of the GoI, for the
removal of the old Cobalt-60 sources, procurement of new linear
accelerators should the U.S. or other donor be unwilling to supply
new Cobalt-60 sources and machines, and long term financial support
for the Iraq/PACT partnership in areas of USG interest such as
training. (NOTE: While PACT has requested USG support, the
partnership concept along with the three Phase approach has not yet
been approved by the Ministry of Health or Ministry of Science. END
NOTE)

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COMMENT
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9. Mission believes the GoI and PACT are on the right track in
forming a strategic partnership to create a comprehensive national
cancer therapy program and mobilize necessary resources, not funded
by TC monies, to ensure that all three phases of the initial concept
come to fruition. The USG continues to support PACT's work and
given our strategic interests in Iraq and the region, support for
this endeavor, either through training of Iraqi experts, removal of
Cobalt-60 sources, or other forms of aid, would create good will and

ensure that nuclear techniques are being used for peaceful purposes.
There are also benefits in Vienna given Iraq's presence on the IAEA
board and the Iraqi governor's personal concern with nuclear
medicine. Mission suggests that before any USG funding or in-kind
support is considered, a thorough review of the project (possibly
via DVCs with Iraqi experts, the US Health Attach and USAID Bagdad,
and IAEA officials) be conducted. The USG may also want to consider
working with the Minister of Health and Science specifically to set
aside Iraqi national funds, on an annual basis, for specific needs
in all three phases of the concept, thereby reducing the burden on
potential donors.

SCHULTE